Compelling evidence of breastfeeding (BF) mother and child benefits and ongoing efforts to promote BF, have led to slow inclines in BF initiation, but unfortunately not sustained or exclusive BF up to 6 months, especially among African American women (AA). Because of concern about associated mother and child health risks, the extent to which BF self-efficacy (BFSE) and perceived social support (PSS), two important potential influencers of BF decisions (initiation, duration and exclusivity), influence BF behavior among AA was examined. We also qualitatively determined how these variables and other factors can impact success of AA in achieving BF goals. Fifty-three AA enrolled in a 2-arm randomized, controlled, feasibility trial of BF support and post-partum (PP) weight management (MAMA Bear). Perceived social support, BFSE, and other key variables were collected longitudinally (prenatally, 2-8 weeks PP, and 20 weeks PP). Controlling for potential confounders (stepwise selection), impact on BF duration and intensity but not initiation (high rate of 75%), were assessed. BF self-efficacy and PSS, moderately correlated, were assessed independently. After completing the first part of the MAMA Bear study, women (n=14) were recruited around 20 weeks PP until data saturation, to participate in semi-structured qualitative interviews that were digitally recorded and transcribed. Inductive thematic content analysis was conducted in conjunction with a review of field notes.Breastfeeding self-efficacy measured prenatally (β= 2.31, p.05; β= .114, p.017), and between 2-8 weeks PP (β= 3.10, p.01; β=.188, p .001) for all participants, was positively associated with BF duration and BF intensity at 2-8 weeks respectively in fully adjusted models. At 20 weeks PP, BF self-efficacy was associated with BF duration (simple linear regression), but no longer significant after adjusting for relevant covariates. Breastfeeding self-efficacy 2-8 weeks PP positively influenced BF intensity at 20 weeks PP (B=.165, β= .658, p .05). Perceived social support between 2-8 weeks PP was positively associated with BF duration in the usual care group (β= 1.33, p.05), but there was no association for the combined group. Perceived social support prenatally in the combined group, was associated with BF intensity between 2-8 weeks PP in the fully adjusted model (β =.035, p0.05), but not at 20 weeks PP. Two primary qualitative themes emerged for study participants regarding challenges and facilitators in meeting BF goals: BF confidence and discouragement related to BF-related issues. Key BF facilitators were: 1) dual benefit for infant and mother, 2) perseverance 3) commitment and self-determination, 4) fluctuating confidence, 5) ability to pump and, 6) support from identified social support networks. Some suggestions for BF promotion and support included: 1) tangible and immediate help, 2) positive non-judgmental support, 3) “Milk Supply” and “Use of Pump” education, and 4) self-motivation/will power/perseverance. In conclusion, our findings suggest that continual assessment of BFSE and PSS, particularly prenatally and 6 weeks PP, is beneficial in assisting mothers to achieve BF goals and outcomes, in our AA target group. Future interventions can use this strategy and the suggestions from the mothers themselves, for individualized confidence-building to gain a better understanding of time-sensitive needs, and guide healthcare professionals and paraprofessionals on how to better help AA to achieve BF goals. Therefore, collaboration and active engagement with AA and other mothers are encouraged to improve BF promotion, support, and outcomes.
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